Professional Documents
Culture Documents
Francisco Ortega
State University of Rio de Janeiro. Social Medicine Institute. Rio
de Janeiro, RJ, Brazil.
E-mail: fjortega2@gmail.com
Silvia Faraone
University of Buenos Aires. School of Social Sciences. Gino Germani Research Institute. Autonomous City of Buenos Aires, Bs.
As., Argentina.
E-mail: silfaraone@gmail.com
Correspondence
Eugenia Bianchi
Pte J. E. Uriburu 950, 6to piso. Ciudad Autnoma de Buenos Aires,
Bs. As., Argentina. C1114AAD.
Abstract
From a critical analysis of medicalization studies, and
as a contribution to these perspectives, we describe
and analyze the ways in which the transnational pharmaceutical industry penetrates diverse social spaces,
with different marketing strategies, to consolidate
medicalized processes in Argentina and Brazil. We
analyzed two expansion methods of medicalization
processes and specific ADHD diagnostic and treatment
aspects and trends were developed in both countries:
the impact of the pharmaceutical industry on advocacy
groups in Brazil and pharmaceutical marketing strategies aimed at non-medical actors in Argentina. These
two methods are characterized by involving other actors than medical professionals. The methodology includes data from research conducted in Argentina and
Brazil between 1998 and 2014, based in the University
of Buenos Aires and in the State University of Rio de
Janeiro, focused on the study of ADHD diagnostic and
treatment processes and methylphenidate consumption in both countries. We used individual and group
semi-structured interview techniques with professors
and health professionals, official and professional organization statistics, and national and international
1 Investigations conducted in Argentina had two financing sources: Silvia Faraone: UBACyT Project of the University of Buenos Aires
Ciencias Sociales, Salud Mental y Derechos Humanos (2012-2014). Eugenia Bianchi: PhD (2009-2014) and Post-doctoral (2014-2016)
scholarships, funded by the Consejo Nacional de Investigaciones Cientficas y Tcnicas (CONICET), who has studied different facets
of the problems linked to the ADHD diagnosis and treatment processes in children in the City of Buenos Aires, between 2007 and 2013
from the perspective of the social sciences. The research conducted in Brazil were funded through the following sources: Francisco
Ortega: Neurocincias, sociedade contempornea e sade coletiva E-26/102/817/2008 Cientista do Nosso Estado Scholarship granted
by FAPERJ from 2/1/2009 to 1/31/2012. Francisco Ortega: Diagnsticos psiquitricos, identidades neurolgicas e sociabilidade contempornea, E-26/102/998/2011 Scholarship granted by FAPERJ from 2/1/2012 to 1/31/2015. Francisco Ortega: Neurocincias, sociedade
contempornea e sade coletiva CNPq-PQ Scholarship, process No. 300655/2010, from 03/01/2011 to 2/31/2014. In addition, another
research was funded through the Post-doctoral Support Program scholarship of the state of Rio de Janeiro CAPES/FAPERJ, process No.
E-26/101.301./2014.
452 Sade Soc. So Paulo, v.25, n.2, p.452-462, 2016
DOI 10.1590/S0104-12902016153981
Resumen
Desde un anlisis crtico de los estudios de la medicalizacin, y como un aporte a estas perspectivas,
describimos y analizamos los modos en que la industria farmacutica transnacional penetra en diversos
espacios sociales, con diferentes estrategias de marketing, interviniendo en la consolidacin de procesos
medicalizadores en Argentina y Brasil. Se analizan
dos modalidades de expansin de los procesos de
medicalizacin, y se desarrollan aspectos y tendencias especficas del diagnstico y tratamiento del
TDAH en ambos pases: la incidencia de la industria
farmacutica en los grupos de apoyo en Brasil y las
estrategias de marketing farmacutico orientadas
a actores no mdicos en Argentina. Estas dos modalidades se caracterizan por no involucrar slo al
profesional mdico. La metodologa incluye datos de
investigaciones conducidas en Argentina y Brasil entre 1998 y 2014, con sede en la Universidad de Buenos
Aires y la Universidade Estadual do Rio de Janeiro,
orientadas al estudio de los procesos de diagnstico y
tratamiento del TDAH y el consumo de metilfenidato
en ambos pases. Se emplearon tcnicas de entrevista
semiestructurada individual y grupal a profesores
y profesionales de salud, estadsticas oficiales y de
organizaciones profesionales, y revisin de bibliografa general y especializada nacional e internacional.
Concluimos que los fenmenos documentados en
Argentina y Brasil ponen de relieve la importancia
de efectuar investigaciones que contemplen aspectos
singulares de los casos empricos, y sus mltiples
vinculaciones con entramados ms amplios y en
tensin de saberes, dispositivos, normativas y actores
involucrados en la medicalizacin en el siglo XXI.
Palabras clave: Medicalizacin; Industria Farmacutica; Grupos de Apoyo; TDAH; Argentina; Brasil..
Introduction
The perspective of the medicalization criticism
has more than half a century (Clarke; Shim, 2011).
Its original definition associated with the expansion of the medical domain has been reconfigured,
currently covering a complex space of intelligibility
that includes the definition, description, understanding, and treatment of a problem in medical
terms (Conrad, 2007, 2013). Initially focused on physicians, social movements and inter-professional
organizations, nowadays, it also targets the transnational pharmaceutical industry, biotechnology,
internet, health markets, and consumers (Conrad,
2005, 2013). These elements reinforce the position
of authors, such as Lupton (1997), who supports
the thesis that the asymmetry between the medical power and patient power is no longer enough
to understand the issues involving contemporary
medicalizing processes.
At the same time, the problems related to the
attention deficit hyperactivity disorder (hereinafter
ADHD) have aroused the interest of different social
thinking frameworks. The line of analysis of the
societys medicalization processes represented by
Conrad and his colleagues, in particular, has been
developing an analysis of ADHD as a paradigmatic
example of such processes and transformations for
40 years (Conrad, 1975; Conrad; Schneider, 1992;
Conrad; Potter, 2003; Conrad; Bergey, 2014).
In the most recent analysis of the globalization
of ADHD conducted by Conrad and Bergey (2014), a
series of mechanisms that contribute to the positioning of the clinical profile as a global diagnosis
is marked. In their work, they rank the incidence of
non-medical actors in the medicalization processes
of ADHD in the 21st century and emphasize the need
to meet different national cases to understand the
migration of the diagnosis of ADHD outside the
United States.
From a critical analysis of medicalization studies, and as a contribution to these perspectives, we
present herein results of researches conducted in
Argentina and Brazil, developing issues and trends
with their own and specific particularities and nuances of the diagnosis and treatment of ADHD in
both countries, through the description and analysis
Sade Soc. So Paulo, v.25, n.2, p.452-462, 2016 453
Methodology
The information analyzed comes from the investigations conducted in Argentina and Brazil. For
the analysis of pharmaceutical marketing strategies for ADHD in Argentina, we use results of two
investigations between 2007 and 2014, both based
at the University of Buenos Aires (UBA). We analyzed specialized literature both in Argentina and
worldwide, national articles about the subject, official and professional organization statistics, and
65 individual and group semi-structured interviews
with health professionals, with clinical, teaching,
and research attachment in the public sector, with
social security and private sector professionals.
Interviews were also conducted with key informants
and pharmaceutical sales representatives (PSR) of
the pharmaceutical industry.
Interviews were conducted in two stages: 35
between October and December 2007, and between
April and June 2008; and 30 from August 2009
until March 2011, in four jurisdictions: Salta, Corrientes, Tierra del Fuego, and city of Buenos Aires.
A non-probabilistic purposive sampling criterion
was followed. Primary and secondary data obtained
were processed with analytical and interpretative
454 Sade Soc. So Paulo, v.25, n.2, p.452-462, 2016
impeding globalization of ADHD, under the expansion of the category outside the United States.
They argue that, although the global information
is sparse, the available data suggest an increase in
the global prevalence of ADHD diagnosis (Polancyk
et al., 2007), and an increase in the consumption of
medication for ADHD in a wide range of countries.
That is why the analysis of ADHD advocacy groups
in Brazil and the pharmaceutical marketing strategies about ADHD aimed at parents and teachers in
Argentina mean a contribution to increase the still
few studies that show how the diagnosis and treatment of ADHD are migrating to different regions of
the globe (Conrad; Bergey, 2014; Zorzanelli; Ortega;
Bezerra, 2014).
Globalized medicalization:
physicians and beyond them
Although the studies conducted in the 1970s
ranked among the most important forces of medicalization to physicians, social movements and
interest groups, and some professional or interprofessional organizations since then to now, the
medicine has shown significant changes, making
other formerly underlying forces to contribute to the
process of medicalization. The most recent perspective outlined by Conrad to address the problems of
medicalization has the peculiarity of not focusing
on the influence of physicians or law reformers,
nor in medical and scientific discoveries. His contribution is focused on the creation of markets, and
the impact of those markets in the medicalization
(Conrad, 2007).
Although the actors involved are similar, the
emphasis of each is different, and this is the main
key to understand the characteristics of the medicalization of society today. With the changes in the
medical setting, important areas of medicalization
are moving from a professional-medical dominance
to a market dominance (Conrad; Leiter, 2004).
Linked to the displacement of the central role of
health professionals is the relevance that, in the
21st century, acquires the consumption, as a general
logic with which to approach the problems related to
medicalization processes. Both Conrad and others
(Conrad; Leiter, 2004; Conrad, 2013; Conrad; BerSade Soc. So Paulo, v.25, n.2, p.452-462, 2016 455
de Janeiro (Itaborahy; Ortega, 2010). In this research, it was found that the publications in the
Jornal Brasileiro de Psiquiatria, major specialized
journal in the country, contain, to a large extent,
research of GEDA, and that many of them included
Concerta drug ads. The conflict of interest regarding the treatment of the users was stated in
them, however in other articles, the financing of
laboratories was not explained. In addition, we
documented that the supplement to this same
journal of the year 2007 was entirely funded
by a laboratory responsible for manufacturing
methylphenidate, from articles to propaganda.
The information gathered leads to consider that
the financing of pharmaceutical laboratories in
research carried out in the country about ADHD
must not be analyzed with a priori criticism about
the validity of them, since the need for funding
for the development of complex investigations
requiring an extensive infrastructure.
However, the direct influence of the presence of
the pharmaceutical laboratories in support of the
research and its main researchers demand a need
for control and evaluation of the process and the
ethical implications arising from such sponsorship.
Conclusions
Medicalization is not an univocal, homogeneous,
or general process. As we argued, Conrad is the
main author who highlights the medicalization as
a variable process, irregular, and uneven, in function of its target and its related social group. By
emphasizing the role of actors outside the medical
field, such as the activities of the pharmaceutical
industry, pediatrics, associations for children with
learning difficulties and the medical journals of the
1960s, the involvement of a multiplicity of vectors
in the medicalization process of ADHD was observed
(Conrad, 1975).
The globalization of ADHD is being configured
with different characteristics in each country,
and with the consolidation and differential insertion of actors and links between them. The two
cases we presented in Argentina and Brazil are
examples of how these processes are occurring,
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Authors contributions
All authors worked together in all instances of the preparation of
the article.
Received on: 09/03/2015
Accepted on: 11/24/2015
462 Sade Soc. So Paulo, v.25, n.2, p.452-462, 2016